原创力文档challenges in managing hospitalized hiv infected persons with low absolute cd4 and preserved cd4 percentage较低的挑战在管理住院艾滋病病毒感染者绝对cd4和保存cd4百分率.pdfVIP
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challenges in managing hospitalized hiv infected persons with low absolute cd4 and preserved cd4 percentage较低的挑战在管理住院艾滋病病毒感染者绝对cd4和保存cd4百分率
World Journal of AIDS, 2012, 2, 237-244 237
doi:10.4236/wja.2012.23031 Published Online September 2012 (http://www.SciRP.org/journal/wja)
Challenges in Managing Hospitalized HIV Infected
Persons with Low Absolute CD4 and Preserved CD4
Percentage
Steven M. Bobula, Carl J. Fichtenbaum
Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, USA.
Email: carl.fichtenbaum@
Received May 18th st th
, 2012; revised June 21 , 2012; accepted July 8 , 2012
ABSTRACT
Background: HIV infected persons are at risk for opportunistic illnesses based upon severity of immune deficiency.
Management is generally based upon the most recent absolute CD4 count. We hypothesized there is a group of patients
with a low absolute CD4 count and preserved CD4 percentage that are at low risk of AIDS-related opportunistic ill-
nesses (OI). Methods: A retrospective review of medical records in HIV-infected persons hospitalized from 2004-2006.
Individuals without CD4 counts available within 180 days of admission and during hospitalization were excluded. Pa-
tients with a decrease in the absolute CD4 count during hospitalization and stable CD4 percentage were compared to the
rest of the cohort. Appropriate management was defined using DHHS guidelines for the prevention and treatment of
opportunistic illnesses in HIV infection. Results: 464 patients had 978 hospitalizations. In 221 hospitalizations (N =
161 patients) inpatient and outpatient CD4 counts were available. In 35 hospitalizations (N = 25 patients) the absolute
CD4 count declined with stable CD4 percent (cases). Cases had an average decline in CD4 of –197 cells/mm3 compared
to –5 cells/mm3 in the comparator group. 30% of comparators had AIDS defining OI’s compared to none in the case
group (p =
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